ABSTRACT
This manuscript introduces to the podiatric community the Truncated Cone Reamer (TCR) System for precise fashioning of the first metatarsal and proximal phalanx for a first metatarsophalangeal joint peg-in-hole type arthrodesis. As the name of the system suggests, the device reams out a truncated male cone at the metatarsal head and a corresponding female cone at the phalangeal base in the desired position. There is congruous cancellous bony contact at all apposing surfaces of the truncated cone for bony consolidation. The peg-in-hole intrinsically confers the arthrodesis stability. The authors present a step-by-step use of the TCR system, and a 1 year follow-up case study in which the TCR system was used as a template.
Subject(s)
Arthrodesis/instrumentation , Metatarsophalangeal Joint/surgery , Arthrodesis/methods , Female , Follow-Up Studies , Hallux/surgery , Humans , Male , Metatarsophalangeal Joint/diagnostic imaging , Middle Aged , Postoperative Care , RadiographyABSTRACT
Silicone rubber arthroplasty has been used in the foot with great success and with devastating failure. In an effort to understand why certain cases are successes and why certain cases are failures, a systematic investigation of several factors is necessary. A certain relationship exists among the material of which the implant is made, the design of the implant and the function it is asked to perform, and the host response to the material or implant. Simply because a material has been shown inert when placed in relatively large pieces in the body is not reason enough to support its use. The design of the implant must be such that it re-establishes function parallel to an anatomic manner. Host response to a prosthesis may be viewed in light of the tissue response to the foreign body and also with regard to its effect on bone, synovium, and articular cartilage as an organ. One must consider not only biologic compatibility but also compatibility of physical properties and physiologic function. This article has attempted to address and organize implant surgery in just this manner described. Silicone rubber arthroplasty has been a very satisfying procedure for both patient and surgeon. Complications do occur, and it is up to the surgeon to provide the analysis. The manufacturer may provide the prosthesis but the responsibility lies with the surgical community to use implantation in a proper and appropriate manner.
